Investigating the effectiveness of employing clinical faculty members in the shift work system during the Covid‐19 pandemic in Iran: A cross‐sectional study

Abstract Introduction Having an accurate attitude about shift work and choosing the right people to work in the shift work system increases organizational productivity and improves the employees' life quality. Consequently, the current research investigates the effectiveness of employing clinical faculty members in the shift work system during the Covid‐19 pandemic. Materials and Methods In this descriptive study, 71 Iranian clinical faculty members with a history of shift work (night shift) during the Covid‐19 pandemic participated. Circadian Type Inventory (CTI) was used to collect data. Results Based on the results of this research (Flexible/Rigid = Mean ± SD = 2.47 ± 18.17) and (Languid/Vigorous = Mean ± SD = 2.89 ± 15.35) which revealed that although clinical faculty members in normal conditions can overcome the feeling of sleepiness due to lack of sleep, they are not flexible and cannot work in the shift work system with the ability to stay awake at unusual times of the day or night. Pearson's correlation coefficient test also showed that as the value of the Languid/Vigorous component increases, the value of the Flexible/Rigid component also increases (r = 0.410). Likewise, there was no significant relationship between the main research variables and demographic characteristics. Discussion and Conclusion Clinical faculty members who are simultaneously responsible for the duties of teaching students, research, and treating patients, if they are employed in a shift work system, especially during the pandemic, it may lead to a decrease in the quality of teaching, lack of motivation in research and indifference toward students' affairs, reducing flexibility, inability to update what they have learned in the professional world, increasing medical errors and also reducing their ability to manage the class. Consequently, it is suggested to avoid using them in the shift work systems as much as possible.


| INTRODUCTION
Any work that can be done regularly and outside of the daily work period (7 a.m. to 6 p.m.) is called shift work. 1 With the incident of the industrial revolution and the advancement of science and technology, particularly the invention of artificial light sources, human life changed, and a 24-h society emerged. Due to economic, technological, social, and service needs, the organizations started working around the clock, 7 days a week. 1,2 A circadian rhythm is a physiological cycle that repeats approximately every 24 h. Many processes follow circadian rhythms, including the sleep-wake cycle, hormonal changes, body temperature, and blood pressure. 3 Shift work is one of the harmful factors of the work environment in the field of organizational ergonomics, it can have adverse effects on the productivity of the organization and the quality of human working life from various aspects. 4 Shift work sleep disorder (SWSD), characterized by insomnia and excessive sleepiness associated with shift work, is one of shift workers' most common health problems. Shift work disorder causes insomnia, fatigue, worse work performance, increased risk of accidents and low quality of life. Furthermore, SWD is associated with reduced productivity and increased economic costs. 5 Shift work has numerous harmful effects on employees' health, which can be mentioned such as the effect on the circadian and sleep-wake cycles, adverse effects on family and social life, and long-term effects, including digestive and cardiovascular problems and the risk of neuropsychiatric diseases. 6 Shift workers, precisely women, are exposed to various mental problems, specifically depression symptoms. 7,8 The tendency to bad habits is more in jobs that are done at night. Shift work can change the pattern of food consumption. To fight fatigue and sleepiness, night workers tend to consume readily available food such as sausage or foods with high sugar, fat, and caffeine. Examining data and physiological mechanisms also indicates the relationship between shift work and the occurrence of gastrointestinal diseases. Shift workers give up their work activities due to physical and mental discomforts and turn to drug treatment to solve their problems. It has also been found that these people incline to smoke to deal with insomnia, 9 and it has been revealed that disruption of the circadian rhythm is the cause of some cardiovascular risk factors such as hypertension and high blood fats. 10 In Iran, the medical education system and the healthcare service delivery system have been merged, as a result of which there are currently 68 universities of medical sciences and healthcare services, whose clinical faculty members, in addition to teaching and research, are responsible for treating patients in teaching hospitals. 11 Doctors who are obliged to work in shift systems are more exposed to wrong decisions in their career. They may have a more hostile attitude towards patients, make more medical mistakes, and have complicated relationships with their colleagues. Clinical faculty members who, as well as treating patients, are also responsible for teaching students and conducting research at the same time may have problems if they work in a shift work system. Consequently, having the right attitude about shift work and choosing the right people to work in the shift "Flexible/Rigid," from 5 questions related to the FR factor are part of the 75th percentile. Therefore their circadian type is considered flexible in terms of rhythm. These people can stay awake at unusual times of the day and night. Also, people who score above 22.5 in the second factor called "Languid/Vigorous" out of 6 questions related to the LV factor are above the 75th percentile, and therefore their circadian type is considered weak in terms of range. It is more difficult for these people to overcome sleepiness. The validity and reliability of this questionnaire have been confirmed in Iran. 12 Questionnaires were distributed electronically and through What-sApp messenger among the clinical faculty members. The data were analyzed using SPSS version 24 software at a significance level of 0.05 and with the help of mean, standard deviation, percentage, independent t-test, Kruskal−Wallis and analysis of variance.

ACKNOWLEDGMENTS
This research has been carried out in line with the research plan NO.

U-00187 approved by Ahvaz Jundishapur University of Medical
Sciences.

CONFLICT OF INTEREST
The author declared no conflict of interest.

DATA AVAILABILITY STATEMENT
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author. The corresponding author had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.

ETHICS STATEMENT
This research was derived from a research project (Ethics Code of IR.AJUMS.REC.1400.404). Therefore, have been completely observed by the author.

TRANSPARENCY STATEMENT
Abdolrea Gilavand affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.